18-14 Segment 1: The Price Consequences of Doctor Consolidation

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In some areas, it has become almost impossible to find independent physician practices. Many of these smaller practices have opted into being bought by hospitals and other large medical groups. So, what has prompted the increase of consolidation in the medical field? And what does this mean for patients?

The incentives of consolidation have been researched, but the results do not point to one reason. Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine, explains that physicians running smaller practices might benefit from no longer having their own business. Another possibility, Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management at Northwestern University, explains, is that some hospitals may view consolidation as a way to improve the quality of healthcare and decrease the costs to help physicians and their patients. However, data has indicated that the factor with the largest role in consolidation has to do with increasing the amount that hospitals are getting paid, and decreasing the amount paid to pharmaceutical companies. Even though research has not provided an overarching incentive that drives consolidation, the data seems to point to increasing income for hospitals rather than providing patients with better care. Furthermore, hospital consolidation has not been shown to benefit the patient. Dr. Baker explains that data indicates that the cost of healthcare has not gone down for patients with consolidation. Since the cost of healthcare has increased for patients, many have started to wonder how consolidation has been able to continue and what is being done to control it.

In the medical field, it is important to maintain consistency in market concentration and ensure that the markets are still competitive. One way in which authorities in the medical field work to maintain market concentration is by regulating transactions that reach a price threshold. However, Dr. Ody explains that hospitals have been able to avoid these regulations by partaking in multiple smaller transactions that invest in a small number of physicians at a time in order to ensure that the cost is below the threshold for evaluation. By avoiding regulations, hospitals have been able to grow into much larger entities that generate a lot of power and income from smaller practices. Since consolidation has prompted increased healthcare costs, it currently appears to be detrimental to the medical field rather than helpful. Yet, it could be worth it if hospitals were able to determine a method of consolidation that decreases healthcare costs and improves the quality of care that is provided to patients.

Guests:

  • Dr. Laurence Baker, Professor of Health Research and Policy at Stanford University School of Medicine
  • Dr. Christopher Ody, Research Assistant Professor at Kellogg School of Management, Northwestern University

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18-14 Segment 2: The Vaccine Race and Ethics

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Since their creation, vaccines have had a long history of being controversial. Many of the problems surrounding vaccines that we hear about have to do with recent controversies. Yet, their conception has been the center of ethical debates since the 1960s. The founding of vaccines is an important point in history that has allowed for the development of understanding the balance between need and ethics in medicine.

Vaccines were founded from the eminent need to stop the spread of the next horrific epidemic. Dr. Meredith Wadman, reporter for Science magazine and author of The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease, explains that the devastation of the Rubella epidemic that occurred from 1964 to 1965 influenced the race to find a vaccine to help prevent the breakout of another epidemic. However creating vaccines involves reproducing the viruses which can only be done with cells. Originally, scientists used monkey kidney cells, but Dr. Wadman explains that these were expensive to obtain and they came with a number of safety issues. So, Leonard Hayflick, a researcher, developed the idea of using human cells, a concept that, Dr. Wadman, explains has garnered the attention of ethics debates because he used cells obtained from a fetus without the consent of the women who had given up the fetus. The cells from this fetus that were used in the 1960s are still being used today in order to develop more vaccines that have been used to save hundreds of millions of people.

How do scientists justify the ethics of this decision to people who do not agree with abortion? Dr. Wadman explains that it is important to look at the larger picture because it is not an ongoing process. Since 1960, this one fetus has been used to save the lives of a number of people. But, this reasoning should not be used to justify all unethical matters. Dr. Wadman explains that the race to find a vaccine was later used to rationalize an abuse of power during World War II in which researchers in America began to test on institutionalized people, prisoners, and even premature newborns and intellectually disabled children, in order to create a vaccine against influenza. At the time, these practices were not regulated, but over time protections and rules were implemented that no longer made it possible for experiments of this nature to take place. While the need for a vaccine can appear to be vital, especially when there are lives on the line, it is important that researchers do not forfeit ethics.

Guests:

  • Dr. Meredith Wadman, reporter at Science magazine and author of The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease

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Medical Notes 18-14

 

Medical Notes this week…

How safe is vaping? A new study in the journal Environmental Health Perspectives says it’s not. Researchers say people using e-cigarettes are likely to inhale significant amounts of lead, chromium, manganese and other toxic metals. The problem apparently isn’t in the e-liquids the devices use. It’s the heating coils that leak heavy metals. Scientists say that nearly half of the aerosol vapers tested had lead concentrations higher than health limits defined by the epa.

A lot of people, including doctors, mistakenly judge a person’s health by their weight. But a new study in the journal BMC Obesity finds that it’s very possible to be healthy and fit even if you’re obese. Scientists tested more than 800 people and found that more than 40 percent of those with mild obesity still had high fitness levels. Twenty-five percent of those with moderate obesity had high fitness and 11 percent of those with severe obesity still had high fitness. Researchers say it takes a lot less physical activity to improve health than to lose weight.

And finally, scientists have determined that money can, indeed, buy happiness but it takes the right amount of cash. Too much can be as bad as too little. A global study in the journal Nature Human Behavior finds that 60-to-95 thousand dollars per year is the ideal income for a single person. Researchers say income greater than that is likely to prompt the pursuit of more material gains and social comparisons, which make people less happy.

And that’s Medical Notes this week.

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